What are the cardiovascular and liver effects of Lean Mass Accelerated Sarcopenia Loss Diet (MASLD)?

From the Guidelines

The Lean Mass Accelerated Sarcopenia Loss Diet (MASLD) has significant cardiovascular and liver effects, and management should prioritize weight loss, dietary modification, and exercise, with a focus on maintaining muscle mass and reducing the risk of sarcopenia, as recommended by the most recent guidelines 1. The cardiovascular effects of MASLD include an increased risk of major cardiovascular events, particularly in adults with MASLD who are candidates for liver transplantation 1.

• The liver effects of MASLD include steatosis, steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma, with a strong association between liver dysfunction and cardiovascular damage 1.
• Management of MASLD should focus on weight loss, with a goal of reducing BMI to <40 kg/m2 and ideally <35 kg/m2, through dietary modification and supervised physical exercise, as this can improve peri-operative outcomes and reduce the risk of cardiovascular events 1.
• Bariatric surgery can be considered in adults with non-cirrhotic MASLD who have an approved indication, as it can induce long-term beneficial effects on the liver and is associated with remission of type 2 diabetes and improvement of cardiometabolic risk factors 1.
• Statins can be used in adults with chronic liver disease, including those with compensated cirrhosis, to reduce cardiovascular events, and GLP1 receptor agonists and SGLT2 inhibitors can be used in adults with Child-Pugh class A and B cirrhosis, respectively 1.
• Regular monitoring of liver enzymes, cardiovascular risk factors, and periodic imaging of the liver is recommended for patients with MASLD, and a comprehensive screening for comorbidities should be performed before liver transplantation to mitigate the risk of major cardiovascular events 1.

From the Research

Cardiovascular Effects of Lean MASLD

• The study 2 found that lean MASLD patients have a 50% increase in cardiovascular mortality odds compared to non-lean MASLD patients.
• The odds of major adverse cardiovascular events (MACE) were 10% lower in lean MASLD patients, but this difference was not statistically significant.
• Lean MASLD patients had 40% lower odds of cardiovascular disease (CVD) compared to non-lean MASLD patients.
• The study 3 highlights the importance of assessing and managing cardiovascular disease risk in patients with MASLD, as cardiovascular disease is the leading cause of mortality.

Liver Effects of Lean MASLD

• The study 4 provides an overview of the definition, epidemiology, pathogenesis, and clinical outcomes associated with lean individuals with MASLD.
• The study 5 found that lean MASLD patients have a worse prognosis compared to obese or overweight counterparts, with a higher prevalence of metabolic syndrome, hypertension, and type 2 diabetes mellitus.
• The study 6 suggests that statin use may be beneficial in patients with NAFLD/NASH, with some statins (such as atorvastatin and rosuvastatin) showing significant histological ameliorating effects and reducing CVD events.
• The study 3 notes that no pharmacological agent has been approved for the treatment of MASLD, but novel anti-hyperglycemic drugs and medications used for the treatment of diabetes and other metabolic conditions may be beneficial in managing the disease.

Management and Treatment of Lean MASLD

• The study 3 emphasizes the importance of lifestyle intervention in the management of patients with MASLD, with a focus on reducing hepatic steatosis and improving cardiometabolic profiles.
• The study 5 suggests that non-invasive tools, such as the Fibrosis-4 index, may be useful in diagnosing and monitoring lean MASLD patients.
• The study 6 recommends selecting specific statins (such as atorvastatin or rosuvastatin) that offer substantial liver- and CVD-related adverse event reduction in patients with NAFLD/NASH.